Tuesday, April 29, 2014

Hospice is good when needed but not in Mom's case...

Mom continues to be the same - good vitals, eats well, happy to sit, watch and snooze.  Holds her baby all the time and, as I found again today, is very surprised at the weight of a real baby when she has the opportunity to hold one.  :)
Enjoying her great granddaughter again - and boy is she heavy!
I continue on my endeavor to minimize her expenses without compromising her care and happiness.

I finished the audit of her ALF expenses and found only a small error over the course of the three years.  It was recent and just an oversight.  Hospice took over bathing Mom and the ALF forgot to remove that from the service plan.  They were very responsive to my concerns and they are crediting the charges.

As I mentioned in a previous post, I had the oxygen machine returned.  Mom had never used it and my research revealed that there is now a monthly oxygen charge whether it is used or not.  It used to be that charges were for actual use.  Big change!

Looking further into the charges and services provided by hospice, I was shocked to find claims submitted to Mom's insurance company in amounts between $3,400 and $3,800 a month!  Oh my goodness!  They check her vitals weekly and bathe her twice a week.  She takes no meds and requires nothing medically.  What in the world are we paying for??

I'm still trying to find that answer but while I'm waiting for an itemized bill, I've asked the ALF to see if there are any services that hospice provides that they can't.

It would be different if Mom had medical issues other than the possibility of a hemorrhage that gives her no pain.  Hospice is not with her 24/7 like the ALF staff is so the likelihood of them being on site if Mom hemorrhages is slim to none.  It is far more likely that anything that happens will be handled by the ALF staff and Mom is used to them.

While hospice is a good thing in many cases, Mom just isn't one of those cases.  I anticipate eliminating their services in the next couple of weeks.

Wednesday, April 23, 2014

She's still walking!

I now take care of my four month old granddaughter every day and yesterday I took her to visit Mom.  Mom was so happy to see her!  She told her, "Grandma loves you!"

We arrived just as Stephanie was getting ready to bathe Mom.  Mom was in her rocking chair in the living room rather than her wheelchair so we stood her up and she walked with Stephanie back to her room.  That was quite a way but I think seeing her great granddaughter put a spring in her step.  :-)

Mom didn't complain about starting the process but once her clothes were removed, she started her normal fussing.  She was shaking her fist at Stephanie and I stepped in, telling her that she had to have a bath and it would be okay.  I started the water and got it warm to show her she would like it.  She calmed down but said she would just leave!  I fell back to a couple of our old conversations, telling her that she could leave when God's ready for her but until then Grandma (her mama) said she had to have a bath.  It doesn't always work but it did again this time!

Although not a long visit, it was a good one.  Mom didn't know names but she recognized our relationship and had lots to talk about.  I love those kind of visits!

Sunday, April 13, 2014

What’s really needed as Mom turns 98?

Last weekend we had an open house at the ALF for Mom’s 98th birthday.  She was thrilled to see everyone and definitely enjoyed her ice cream and cake!  The day was sunny and bright and although it was too chilly for her to go out in the courtyard, we were able to keep the door open and family members were able to check out the facility’s courtyard and enjoy the sunshine.

Leading up to and now after her birthday, I can’t help but wonder what is really needed for Mom.  She spends her days in her wheelchair or her favorite rocking chair holding her favorite baby doll.  She enjoys sitting where she can view the entire room and into the dining area so she can see everyone who walks in the door and what the various workers and residents are doing.  When she is awake, that is.  She snoozes a lot.

Happy day when she gets to hold a great grandchild!

She’s not able to stand for very long and can walk only short distances with help.  That, and the fact that she has forgotten all the ways to care for herself, means she has to have help with dressing, baths and toileting.  At times she even needs to be reminded how to eat.

She’s definitely where she needs to be – in an assisted living facility where they help her with all those “activities of daily living” and understand that her memories are fleeting.  Her memories come and go from moment to moment but she is happy in her “home”.

Living in a facility is very expensive whether it is a nursing home or an assisted living facility.  The decision to place a loved one requires a lot of financial planning and quite often funding from Medicaid.  Not all facilities accept Medicaid and we knew Mom’s did not when we placed her there.  We had to plan for Mom’s expenses to be paid from her income as Daddy’s surviving spouse.  We really like the facility and so does Mom so as time goes on and fees rise, it’s our job to find ways to keep her there and also watch over the expenses she is charged to make sure they are needed.

Late last year I submitted paperwork to the VA to apply for Aid and Attendance benefits for Mom.  As the spouse of a veteran who served during a war (Daddy was in WWII), she is entitled to a monthly benefit.  She received her first payment on April 1 and while it is not a large amount, it helps.

I’ve recently audited the charges from the ALF and my next step is to look into hospice costs.  When hospice was first suggested, it was because there was suspicion of a problem in her abdomen and finding the mass set the hospice wheels in motion.  It seemed at the time to be initiated for a good reason and I was told that Medicare would pay for it all.  That might be true for most but as it turns out, not for Mom.  Daddy was a teacher and she is covered under his medical as his survivor.  The only Medicare they were entitled to was Part B (physician) which doesn’t cover hospice.  The medical plan is actually the primary payer for Mom’s hospice expenses.

Here we are, seven months later and there has been no change in Mom’s condition.  It fluctuates as it always has but nothing out of the normal range.  She’s not in pain, not on any medication and they’ve put an oxygen machine in her room that she has never used.  Her vitals are always good when the hospice nurse comes once a week.  I know she has a ticking time bomb in her abdomen that could hemorrhage at any moment but does that really require more watching than she gets from the ALF nurse and aides?  My siblings and I joke that Mom will still be here to see 105!

It’s possible that the hospice expenses are less than if the same services are provided by the ALF so it may make sense to have hospice overseeing her care given her condition.  It’s something I will begin investigating this week and checking to see if Mom needs everything provided – I’m thinking the oxygen can go if nothing else.